MR. TIMOTHY BLACK (PA) – Surgical Physician Assistant, NPI 1730167271
Surgical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,282 PHYSICIAN ASSISTANT in WA
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Provider Addresses for MR. TIMOTHY BLACK (PA)
Northeast Mother Joseph Place, Vancouver, Clark County, Washington, 98664, United States
VANCOUVER, WA 986643295
Phone: (360) 254-6161
Fax: (360) 449-1146
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2016-09-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20160916000907 | I | Physician Assistant | WA | TBD |
| I20160919001707 | I | Physician Assistant | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 73030 | X-ray of shoulder, minimum of 2 views | 83 | 68 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 50 | 46 | $0 |
| 23472 | Prosthetic repair of shoulder joint, total shoulder | 32 | 32 | $0 |
| 20610 | Aspiration and/or injection of fluid from large joint | 29 | 26 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 29 | 28 | $0 |
Insurance plans in this area (ZIP 98664)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | WA | |
| Family Practice, Sports Medicine | OR | |
| Physical Therapist In Private Practice | WA | |
| Physical Therapist In Private Practice | OR | |
| - | WA | |
| Physician Assistant | WA | |
| Physician Assistant | WA | |
| Orthopedic Surgery, Hand Surgery, Orthopedic Surgery | WA | |
| Physician Assistant | OR | |
| - | WA |
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